Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices is a report published on May 1, 2025, by the United States Department of Health and Human Services (HHS). It was produced at the direction of President Donald Trump's Executive Order 14187 which explicitly called for limiting access to gender-affirming care for young people. The report was characterized by the American Academy of Pediatrics as "misrepresent[ing] the current medical consensus".
The names of the authors of the report were not disclosed until November 19, 2025; the American Psychological Association characterized this conduct as "...undermin[ing] scientific rigor and contradict[ing] standards for evidence-based policymaking". When the authors were revealed, many were found to be prominent anti-transgender activists who had previously testified in favor of anti-transgender legislation, are affiliated with various anti-LGBT and religious groups and consisted of what Meredithe McNamara of Yale School of Medicine called "a cottage industry that solely exists to dismantle health care for a vulnerable group of people".
The report promotes gender exploratory therapy, a form of conversion therapy intended to delay or prevent gender transition. Advocates as well as medical and psychological experts have said that the report contains misinformation about transgender health care.
The report drew immediate criticism from LGBTQ advocacy groups and medical professionals, with the American Psychiatric Association saying that "its underlying methodology lacks sufficient transparency and clarity for its findings to be taken at face value".
Background On January 28, 2025, President Trump signed Executive Order 14187, "Protecting Children from Chemical and Surgical Mutilation", which directed the HHS to oppose the WPATH standards of care, cease all support for transition of transgender people under the age of 19, and cut federal funding for hospitals that offer transition-related treatments. Because of this, the administration has been noted to have had a predetermined conclusion about gender-affirming care for minors as the executive order called the treatment "blatant harm" and a "stain on our nation's history". The order was released one week into Trump's second term, as part of a series of policies targeting LGBTQ rights and transgender healthcare and gave the HHS just 90 days to complete the report.
Beginning on January 31, 2025, agencies and research institutions under the purview of the HHS were ordered to remove content with "forbidden terms", including "gender, transgender, pregnant person, pregnant people, LGBT, transsexual, non-binary, nonbinary, assigned male at birth, assigned female at birth, biologically male, biologically female". Editors of The BMJ (a British medical journal) published an opinion article in reaction to the order, stating that medical journal editors should resist the US government's order to retract scientific papers for containing certain words. The European Journal of Public Health published an editorial in agreement with The BMJ. Researchers have criticized the Trump administration for censorship of science, and a letter signed by "nearly 2,000 leading scientists" argued this created a "climate of fear" in scientific fields.
Various organizations, including the World Professional Association for Transgender Health (WPATH), American Academy of Pediatrics, and American Medical Association, support access to gender-affirming care for youth.
Report The report is limited to children, and does not address treatment for adults. HHS said its report is not clinical guidance and does not make any policy recommendations. In a press release, the HHS highlighted that the report's authors would be confidential.
The report is around 400 pages and outlined 17 systematic reviews which studied the outcomes of gender-affirming care in minors, but also excluded "thousands of others for not meeting study criteriaincluding some excluded for publication bias."
The report claims that gender-affirming care is experimental without evidence of benefits, and that treatments such as puberty blockers and gender-affirming hormone therapy are unethical interventions pushed by activists. It supports gender exploratory therapy, generally considered a form of conversion therapy, as the only safe treatment for gender dysphoria and argues it is not the same as conversion therapy. The report states that medical groups support medical treatment over psychological treatment due to a "mischaracterization of such approaches as 'conversion therapy, and states that "[p]sychotherapy is a noninvasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria." Additionally, it promotes misinformation about rapid-onset gender dysphoria, a scientifically unsupported hypothesis that transgender identity can be caused by a social contagion. The report also lists autism as a possible cause of transgender identity, citing sources such as gender exploratory therapist Kenneth Zucker.
The report references controversial sources, including the UK's Cass Review, which it cites 149 times, as well as publications by Society for Evidence-Based Gender Medicine (SEGM), journalist Jesse Singal, and SEGM member Lisa Marchiano. Them writer Samantha Riedel described the report as citing "debunked and discredited anti-transgender sources". It also deadnames and misgenders transgender historical figures such as Lili Elbe and Christine Jorgensen.
During a press conference at the White House following the report's release, Stephen Miller, the White House Deputy Chief of Staff, called gender-affirming care "barbaric", further stating that "[t]hey violate all sound medical ethics. They are completely unwarranted. They harm children for life irreversibly. It is child torture. It is child abuse. It is medical malpractice."
Post-publication review and author reveal The authors of the report were not initially named in the report and following the report's release, the HHS declined to identify them. Following the first release of the report on May 1, 2025, HHS had only referred to the authors as "eight scholars including doctors, ethicists and a methodologist who represent a wide range of political viewpoints", and that names were withheld "in order to help maintain the integrity" during post-publication peer-review.
On June 26, 2025, Alex Byrne, a philosophy professor at MIT, wrote an opinion article in The Washington Post claiming to be one of the authors, but did not identify the other eight authors he said were involved in the report.
On November 19, 2025, the HHS re-released the review with a few minor differences and a handful of peer review comments. However, the updated report still comes to the same conclusion as the earlier version. The new report also revealed the names of the authors and their affiliations to be: Evgenia Abbruzzese, co-founder of the Society for Evidence-Based Gender Medicine (SEGM) Alex Byrne, of the Massachusetts Institute of Technology Farr Curlin, of Duke University Moti Gorin, of Colorado State University Kristopher Kaliebe, of the University of South Florida Michael Laidlaw, an endocrinologist in California Kathleen McDeavitt, of Baylor College of Medicine Leor Sapir, of the Manhattan Institute for Policy Research Yuan Zhang, founder of Evidence Bridge
The new updated report immediately attracted criticism from medical professionals and LGBTQ+ rights groups since many of the authors and multiple of the peer reviewers are outspoken opponents of gender-affirming care and have little or no experience working with trans people. Some had also been paid to speak, consult, or testify in favor of banning gender-affirming care. All of the authors are also affiliated with one or more of the following anti-LGBTQ+ or religious groups: Alliance Defending Freedom, American College of Pediatricians, the Society for Evidence-Based Gender Medicine (SEGM), Do No Harm, Moms for Liberty, the Family Research Council, Women's Liberation Front or Genspect, all of which are classified as hate groups by the Southern Poverty Law Center (SPLC). One of the authors, Laidlaw, had been cited by the June 2025 United States Supreme Court in the case United States v. Skrmetti to defend upholding state bans on gender-affirming care.
Most of the peer reviewers agreed with the report's conclusions overall, but some pointed out methodological flaws. One of the peer reviewers Jilles Smids, said that while the report gives a "well-argued analysis", "it is clearly not a neutral report" and that it "decidedly argues against early medical intervention for minors". Another peer reviewer, Richard J. Santen said he used Google Gemini to come up with his review. While Santen said the report makes a "strong case" for gender-affirming care being experimental, he also believed "this conclusion can reasonably be disagreed upon".
In response to the reveal of the authors, Scott Leibowitz, a child and adolescent psychiatrist, said "Now we know why the authors were previously kept anonymous" and said "Reports focused on transgender and gender diverse individuals, especially those commissioned by the U.S. government, should be authored by experts who have dedicated their careers to serving the patient population. Regrettably, this is one of the only fields in medicine where having experience and understanding the complexities are viewed as deterrents rather than assets." Meredithe McNamara of Yale School of Medicine described the list of authors as "engineers of a cottage industry that solely exists to dismantle health care for a vulnerable group of people". The Human Rights Campaign called the updated report a "sham" and "a political document".
The American Medical Association (AMA) and the American Academy of Pediatrics (AAP) released a joint statement condemning the updated report and denying accusations that gender-affirming care is "negligent or ideologically driven" and particularly took issue with "the false assertion that our members have committed 'malpractice' or betrayed their oath in any way". They also claimed these accusations were "rooted in politics and partisanship, misrepresent the consensus of medical science, undermine the professionalism of physicians, and risk harming vulnerable young people and their families". Physicians for Reproductive Health president Dr. Jamila Perritt, OB/GYN, released a statement criticizing the report calling it "pseudoscience" and "grounded in hateful ideological language".
The HHS Assistant Secretary for Health Brian Christine, released a statement saying the updated report is "an urgent wake-up call to doctors and parents about the clear dangers of trying to turn girls into boys and vice-versa". NIH Director Jay Bhattacharya released a statement saying the updated report "meticulously documents the risks the profession has imposed on vulnerable children. At the NIH, we are committed to ensuring that science, not ideology, guides America's medical research" and HHS Secretary Robert F. Kennedy Jr. heavily criticized major medical associations for supporting gender-affirming care, saying that they "peddled the lie that chemical and surgical sex-rejecting procedures could be good for children", and were committing malpractice.
Reception LGBTQ rights organizations Shannon Minter, legal director of the National Center for Lesbian Rights, said the report "seeks to erase decades of research and learning, replacing it with propaganda". The Trevor Project director Casey Pick warned that it could endanger transgender youth. GLAAD CEO Sarah Kate Ellis said that the report is "grossly misleading and in direct contrast to the recommendation of every leading health authority in the world".